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Neoplasm staging

Definition

Neoplasm staging is a system for describing the extent of spread of tumours in patients. For example, the TNM classification of malignant tumours is a staging system used for describing the size of the primary tumour (T), if regional lymphnodes are involved (N) and the presence of metastasis (M).

Renal cell carcinoma (RCC) is a neoplasm of the renal epithelium and accounts for >90% of kidney cancers. Cancer genomic studies have identified numerous molecular events that lead to RCC and marked intra-tumour heterogeneity, which have prognostic and therapeutic relevance. In this Primer, the authors describe these advances, as well as highlight the considerable advances in the systemic treatment of metastatic RCC.

Both the cure rate and morbidity of upper urinary tract urothelial carcinoma are sensitive to nuances of treatment so appropriate management is crucial. Here, Chromecki et al. discuss a number of potential prognostic factors—encompassing clinical characteristics, pathological factors and molecular markers—that might be utilized clinically to identify patients in need of more-aggressive therapy.

Sentinel lymph-node biopsy is an accurate staging procedure for patients with melanoma. However, this procedure followed by immediate completion lymph-node dissection (CLND) does not seem to improve survival, based on data from the MSLT-1 randomized trial. Patients with micrometastases <0.1 mm have a similar clinical course to sentinel-node-negative patients and routine CLND may not be indicated in these patients. The authors discuss the issue of prognostic false positivity and explain how the Rotterdam Criteria could be useful for the measurement of sentinel node tumor burden.

News and Comment

Accurate detection and monitoring of treatment responses is an essential element of the management of patients with lymphoma. In this Perspectives, the authors describe the evolution of lymphoma staging criteria and highlight unaddressed questions, which, if answered, will substantially improve the management of patients with lymphoma.

Active surveillance is a safe and cost-effective method to manage patients with recurrent papillary, low-grade, Ta bladder tumours. New long-term data from a large patient cohort confirm previous findings that emphasize the benefits of limiting the number of surgical procedures requiring anaesthesia and hospitalization in these, often elderly, patients.